Contents

Prophylaxis in Surgery for Adults

NOTE: Use Antimicrobial Surgical Prophylaxis Order Form for all adult, inpatient surgical procedures.

Allergies – True drug allergy is based on the presence of a positive patient response to one or more of the following signs/symptoms: respiratory difficulty, hypotension, rash, or hives. In the absence of these findings, the patient likely experienced an adverse effect but NOT an allergic reaction to the antibiotic. An antibiotic of the same classification may be used for surgical prophylaxis.

Surgical Antimicrobial Prophylaxis Recommendations

Abdominal (e.g., appendectomy (non-perforated), biliary, colorectal surgery of any type, gastroduodenal or small bowel surgery)

Pre-op Colorectal prep: neomycin sulfate 1 g + erythromycin base 1 g PO at 19, 18,
and 9 hours prior to surgery

cefoxitin 1 g (2 g if greater than 80 kg) IV x 1 dose

Allergy: metronidazole 500 mg IV + gentamicin 80 mg (100 mg if greater than 80 kg) IV x 1 dose

Post-op No post-op dosing needed.

Cardiac (e.g., coronary artery bypass graft (CABG), CABG with valve implant, pacemaker and other implants)

Pre-op cefazolin 1 g (2 g if greater than 80 kg) IV x 1 dose

Allergy: vancomycin 1 g IV x 1 dose

Post-op cefazolin 1 g (2 g if greater than 80 kg) q8h x 3 doses

Allergy: vancomycin 1 g IV q12h X 2 doses

Cesarean section

Pre-op cefazolin 1 g (2 g if greater than 80 kg) IV x 1 dose after cord
clamping

cefoxitin 1 g (2 g if greater than 80 kg) IV x 1 dose after cord
clamping

Allergy: metronidazole 500 mg IV + gentamicin 80 mg (100 mg if greater than
80 kg) IV x 1 dose after cord clamping

Post-op No post-op dosing needed.

General (e.g., any implanted foreign body, hernia patch)

Pre-op cefazolin 1 g (2 g if greater than 80 kg) IV x 1 dose

Allergy: vancomycin 1 g IV x 1 dose

Post-op No post-op dosing needed.

Gynecological (e.g., hysterectomy (abdominal, vaginal, or laparoscopic))

Pre-op cefoxitin 1 g (2 g if greater than 80 kg) IV x 1 dose

Allergy: metronidazole 500 mg IV + gentamicin 80 mg (100 mg if greater than 80 kg) IV x 1 dose

Post-op No post-op dosing needed.

Head and Neck

Clean procedures

Pre-op cefazolin 1 g (2 g if greater than 80 kg) IV x 1 dose

Allergy: clindamycin 900 mg IV x 1 dose

Post-op No post-op dosing needed.

Clean-contaminated procedures

Pre-op ampicillin/sulbactam 3 g IV x 1 dose

cefazolin 1 g (2 g if greater than 80 kg) IV + metronidazole 500 mg IV x 1 dose

Allergy: clindamycin 900 mg IV x 1 dose

Post-op ampicillin/sulbactam 3 g IV q6h x 4 doses

cefazolin 1 g (2 g if greater than 80 kg) IV + metronidazole 500 mg IV q8h x 3 doses

Allergy: clindamycin 900 mg IV q8h x 3 doses

Neurosurgery (e.g., craniotomy, shunts, laminectomies, and spinal fusion (prosthetic material))

Pre-op cefazolin 1 g (2 g if greater than 80 kg) IV x 1 dose

Allergy: vancomycin 1 g IV x 1 dose

Post-op cefazolin 1 g (2 g if greater than 80 kg) IV q8h x 3 doses

Allergy: vancomycin 1 g IV q12h x 2 doses

Orthopaedic (e.g., internal fixation of fracture and joint replacement (hip or knee), any implanted foreign body)

Pre-op cefazolin 1 g (2 g if greater than 80 kg) IV x 1 dose

Allergy: vancomycin 1 g IV x 1 dose

**infusion should be completed before tourniquet is inflated if used**

Allergy: clindamycin 600 mg IV x 1 dose

Post-op cefazolin 1 g (2 g if greater than 80 kg) IV q8h x 3 doses

Allergy: vancomycin 1 g IV q12h x 2 doses

Allergy: clindamycin 600 mg IV q8h x 3 doses

Thoracic

Pre-op cefazolin 1 g (2 g if greater than 80 kg) IV x 1 dose

Allergy: vancomycin 1 g IV x 1 dose

Post-op No post-op dosing needed.

Urologic (TURP only, otherwise **indicated only for patients with known bacteriuria**)

Pre-op ciprofloxacin 200 mg IV x 1 dose

Allergy: trimethoprim/sulfamethoxazole 160 mg (trimethoprim component) IV x 1 dose

Post-op No post-op dosing needed.

Vascular (e.g., amputation (lower extremity for ischemia), arterial surgery, vascular access devices, implants, or repair)

Pre-op cefazolin1 g (2 g if greater than 80 kg) IV x 1 dose

Allergy: vancomycin 1 g IV + gentamicin 80 mg (100 mg if greater than 80 kg) IV x 1 dose

Post-op cefazolin 1 g (2 g if greater than 80 kg) IV q8h x 3 doses

Allergy: vancomycin 1 g IV q12h x 2 doses + gentamicin 80 mg (100 mg if greater

than 80 kg) IV q8h x 3 doses